Weight-loss surgery for teens raises hopes, along with fears

NEW YORK — As the popularity of stomach surgery has skyrocketed among obese adults, a growing number of doctors are asking, "Why not children, too?"

For decades, the number of kids trying weight-loss surgery has been tiny. The operations themselves were risky, with a death rate of about 1 in 50. Children rarely got that overweight, and when they did, pediatricians hesitated to put the developing bodies under the knife. Only 350 U.S. children had such an operation in 2004, according to federal statistics.

But improvements in surgical technique and huge increases in the number of dangerously obese children have begun fueling a change.

Four hospitals, led by Cincinnati Children's Hospital Medical Center, are starting a large-scale study this spring examining how children respond to various types of weight-loss surgery, including the gastric bypass, in which a pouch is stapled off from the rest of the stomach and connected to the small intestine.

Three more hospitals have won approval from the Food and Drug Administration to test how teens fare with a procedure called laparoscopic gastric banding, in which an elastic collar installed around the stomach limits how much someone can eat.

The FDA has hesitated to approve the gastric band for children, but surgeons at New York University Medical Center reported in the Journal of Pediatric Surgery this month that the device holds promise.

The 53 boys and girls, ages 13 to 17, who participated in NYU's study shed nearly half their excess weight over 18 months, while suffering relatively minor complications.

Crystal Kasprowicz of St. James, N.Y., said she lost 100 pounds from her 250-pound frame after having the band installed at age 17. "I'm a totally different person," she said.

Before the procedure, Kasprowicz said she took medication for a rapid heartbeat and was showing signs of developing diabetes. Every effort she made to stop getting bigger failed. Dieting didn't work, she said. Her heart problems made it hard to exercise. Even walking up stairs was a challenge.

Now, she's off the heart drugs. Her blood-sugar levels are in check. She also feels better about herself.

Children are considered for surgery only after they have spent six months trying to lose weight through conventional methods under hospital supervision. But so far, not a single one has slimmed down enough to rule out surgery, said Dr. Jeffrey Zitsman, associate attending surgeon at Morgan Stanley Children's Hospital.

"That battle can only be won in a few instances," he said.

The studies have followed a huge surge in the popularity of obesity surgeries among adults. The American Society for Bariatric Surgery estimates that more than 177,000 Americans had weight-loss surgery last year, up from 47,000 in 2001.

Not everyone is pleased that children might be next.

"I don't think altering the human digestive tract is a solution to the problem of excess weight," said Joanne Ikeda, a nutritionist emerita at the University of California, Berkeley. "It's one of these quick fixes that isn't a fix at all."

Doctors, she said, still know relatively little about the long-term effects of such operations on the very young.

The federal Agency for Healthcare Research and Quality released a study in July that said four in 10 weight-loss-surgery patients develop complications within six months. Among adults, mortality rates among gastric-bypass patients remain at between 1 in 100 and 1 in 200 patients.

Laparoscopic gastric banding has been shown to have a much smaller death rate — about 1 in 1,000 patients — but complications do occur.

Thomas Wadden, an obesity expert at the University of Pennsylvania School of Medicine, said surgery can be of immense benefit to some teens, especially those already experiencing health problems.

But he also advised caution.

Egged on by TV shows and commercials expounding the benefits of weight-loss surgery, adult patients have begun showing up at Penn's Center for Weight and Eating Disorders demanding an operation as an easy first step to thinness.

"When we ask them, 'What have you done so far to lose weight?' The patients say, 'Nothing,' " Wadden said. "They're going right to a $25,000 operation for which they are ill-prepared."

It would be tragic, he said, to see the same phenomenon repeated among children.

"They have to be selected with caution to make sure that this aggressive step is absolutely necessary."